November 18, 2021

One of the hottest topics in medical aesthetics in the 2020s has been ultrasound.

Dr Tim Pearce has recently bought an ultrasound scanner too, and it cost nearly as much as many people would expect to spend on training in their first couple of years in aesthetic practice. Therefore, it is not an easy investment decision to make for a small practice – should you buy one or not? Dr Tim has decided to jump on board, but he reassures clinicians that it does not necessarily mean that you should too; keep reading to find out why.

In this blog, Dr Tim Pearce asks, is ultrasound going to become an essential part of every aesthetic practice? Are they just a tool for the inquisitive, worse still, maybe just a status symbol? A toy for the top dogs, without making any material difference to the average patient and the job at hand? Will you need one just to keep up with the Dr Joneses, or will patients start to demand ultrasound scans to feel safe? Dr Tim looks at how the small, single-handed, aesthetic clinician-led practice can decide whether their next big purchasing decision is an ultrasound scanner.

Dr Tim will be discussing more medical aesthetic training tips as part of his upcoming webinar series, so if you’re looking to increase your CPD-certified learning and want to learn more skills to make you a better clinician, then step one is to register for the free webinars by Dr Tim.

Which Ultrasound scanner did Dr Tim Pearce buy?

Ultrasound Scanner for AestheticsDr Tim Pearce has recently bought a Clarius L20 portable ultrasound scanner for his medical aesthetic practice and training academy.

He’s thrilled with it and if anyone stands still long enough – wife, children, work colleague – he will dutifully scan then, and will soon be using the system on his patients. It is fair to say that he is enjoying using his new piece of kit, and as a lover of all things anatomical, Dr Tim is very excited to experience all the new learning that comes with being the owner of an ultrasound scanner, and notes that they are both educational and great fun for the medical practitioner.

But how should you decide whether you need to buy one?

Is it worth investing in an ultrasound scanner for a small, independent aesthetic business?

It is easy to make the case for buying an ultrasound scanner based on the knowledge that if you can see what is under the skin, you will be safer in your clinical practice. However, it is also possible that the marginal increase in safety is not worth it for the patients who will ultimately be paying for it one way or another as costs increase within your business. Allocating resources with respect to safety can be quite a tricky concept, and there is no such thing as 100% risk free and safe. Every business decision is ultimately a cost-benefit analysis, even when taking risks and patient safety into account.

Most of the practitioners who have already invested in an ultrasound device, or are training others in their use, will believe it is of huge benefit. This could be due to their experience, their business model, because they are incentivised to say so, or cognitive dissonance now they have splashed the cash – whereby they try to convince themselves they did the right thing, and they love it.

If you have unlimited resources, making the decision to buy is easy. You can double your appointment time, increase your prices, halve your profitability, but enjoy scanning every patient, and learning lots. However, this is not the case for most aesthetic businesses. It is therefore important to be able to make an educated, real-world guestimate of the potential benefit to both your patients and your business, to establish the return on investment, be that time, money, or peace of mind.

What are the benefits of using an ultrasound scanner in medical aesthetics?

Dr Tim hopes to be able to discover the situations, and frequencies of such situations, in which ownership of an ultrasound scanner can meaningfully benefit both patients and practitioners. Here are some of his thoughts on some scenarios.

  1. Anatomical anomalies
    As he gets more experience with his new device, Dr Tim will be looking to find out how frequently he encounters dangerous or anomalous anatomy within his patient cohort.
    Every patient is different, the arteries always vary in their exact traversal, but this alone is not enough to warrant scanning every patient who comes to the clinic. He explains this could only be challenged if his current rational for injecting in certain areas, based on existing and extensive anatomical knowledge of both arterial pathways and depth could be regularly disproved. This would mean over 1% of cases with ultrasound scans showing abhorrent anatomy which places arteries in direct conflict with needle placement conventions, only then would it be justifiable to scan every patient.
    Such cases of anatomical anomalies, for example, persistent, patent labial arteries which present in the mucosa of the lip in approximately 3% of patients may indeed be best identified with ultrasound, but we would need to know if this was the case, over and above the success rates of identification from physical examination of the patient and palpating the lip. If the latter still works most of the time, as backed up by clinical studies, then do we really need ultrasound?
  2. Preventing vascular occlusions
    Depending on your experience, you may wish to consider ultrasound as a tool to identify arteries before treatment as a means of preventing vascular occlusions (VO).
    Dr Tim notes that it his 12-year experience, he has only encountered one VO whilst injecting himself, (inferior labial artery in the lips), and one similar case when supervising a trainee injector. Considering whether the use of ultrasound would have prevented these two events, he believes that the artery would have been identified and could have been avoided, but given that both VOs were managed immediately and successfully and there was no onward harm to the patient, would ultrasound really be justifiable?
  3. Dangerous places
    As you progress as an aesthetic clinician, you will ultimately inject more and more, and this means that you will start to embark on advanced techniques, injecting in so-called ‘dangerous places’, or providing more niche treatments based on patient requests. You will begin to broaden the scope of your treatment delivery and may consider whether ultrasound will help to guide you as you inject in these areas, such as expanding into non-surgical rhinoplasty, for example. The return on investment may be more apparent in this scenario.
  4. Managing complex vascular occlusions
    For those aesthetic clinicians who are involved in managing complications, and get referrals for such emergencies, consider if you would benefit from having ultrasound to hand.
    Dr Tim explained that in the seven VOs that he has managed through his clinic and training academy, he has never felt that he needed ultrasound to assist with the dissolution of hyaluronic acid; all cases successfully resolved in the normal way. However, he does concede that he has been involved in cases where it was very difficult to ascertain the exact location of the occlusion, within complex arterial anastomoses, and in such cases, ultrasound would have been beneficial.
  5. Treating darker ethnicities
    For those working with a patient cohort made up predominantly of darker skinned individuals, the use of ultrasound may be of benefit to mitigate missed VOs where there could be inadequate blanching on the skin. differentiate well between a haematoma and a VO
  6. Differentiating between haematomas and vascular occlusions
    Dr Tim points out that differentiating between a haematoma and a VO regularly comes up on support forums where practitioners seek advice and guidance from others and is a common concern for many trying to establish the cause of a delayed capillary refill. He suggests ultrasound could be valuable. However, how many times would it be required and used to determine the answer for it to warrant investment?
  7. Diagnosing lumps and nodules
    Diagnosing lumps, bumps, and nodules with ultrasound could be very useful in aesthetic practice, alongside being able to reverse them using ultrasound-guided treatment. This would allow you to visualise and inject directly into encapsulated pockets of filler, for example.
  8. Dermal Filler Complications Ultrasound ScanDissolving in high-risk areas
    Using ultrasound guidance may be of value from a safety perspective when administering hyaluronidase in high-risk areas, such as behind the orbital septum.
  9. Training
    If you are involved in training others, then there is an argument that owning an ultrasound scanner would be beneficial as an educational tool. It would allow you to make the training experience more ‘real’ for the trainees as you can review facial anatomy in a more 3D aspect, looking directly underneath the skin.
  10. If you are paralysed by fear
    Some aesthetic clinicians are essentially paralysed by fear, unable to practice, because, despite their theoretical knowledge, they still believe that something will go wrong when they inject. For such individuals, the visualisation of the needle under ultrasound guidance may help them to feel safer, especially in more complex injection sites, as a mechanism for confidence building.

Dr Tim would love to hear your thoughts on the use of ultrasound in medical aesthetics – while he rushes off to play and learn from this new device – you can always let him know what you think by dropping a comment on social media, you can find Dr Tim Pearce on Instagram.

Aesthetics Mastery Show

ULTRASOUND: Should you buy one to be safe?

This blog follows our recent Aesthetics Mastery Show, in which Dr Tim Pearce discusses the pros and cons of making the investment for your aesthetics clinic.

Are you still anxious about delivering cosmetic injectables safely?

If you want to learn more about mastering medical aesthetic treatments and complications or conquering the anxiety of where to place your needle, then register for the next Dr Tim webinar.

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Further complications resources

If you want to increase your confidence by learning how to handle complications, Dr Tim Pearce offers two comprehensive courses that are highly rated by our delegates:

Both give CPD and certificates on completion.

In addition, browse our FREE downloadable resources on complications.

Dr Tim Pearce eLearning

Dr Tim Pearce MBChB BSc (Hons) MRCGP founded his eLearning concept in 2016 in order to provide readily accessible BOTOX® and dermal filler online courses for fellow Medical Aesthetics practitioners. His objective was to raise standards within the industry – a principle which remains just as relevant today.

Our exclusive video-led courses are designed to build confidence, knowledge and technique at every stage, working from foundation level to advanced treatments and management of complications.

Thousands of delegates have benefited from the courses and we’re highly rated on Trustpilot. For more information or to discuss which course is right for you, please get in touch with our friendly team.

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